UNIVERSITY OF PÉCS
Centre for International Relations
Personal Development Training
Pécs Summer School 2017
Student Application Form
26-28 June, 2017
First name:
Last Name:
I. CONTACT DETAILS:
Address:
ZIP Code:
City:
Country:
Mobile phone:
Home phone:
E-mail:
II. PERSONAL DATA:
Date of Birth:
Gender:
Nationality:
Passport number:
Language(s) spoken:
III. INFORMATION ON STUDIES:
Home university:
Major/main field of study:
Current year of study:
Expected year of graduation:
Degree:
7622 Pécs Vasvári Pál u. 4. Hungary
Telephone: +36 72 501 500/12418 Fax: +36 72 501 508
E-mail: [email protected]
UNIVERSITY OF PÉCS
IV. EMERGENCY CONTACT INFORMATION
First name:
Last name:
Home phone:
Mobile phone:
Work phone:
Email:
Relation to you:
V. ACCOMMODATION
Yes
No
I apply for dormitory placement
VII. ENGLISH LANGUAGE
Is English your first language?
 Yes
 No
If no, please give details of your English language qualifications:
……………………………………………………………………………………………………………………………………………….
……………………………………………………………………………………………………………………………………………….
VIII. SPECIAL NEEDS
Please outline any special needs, support that you may require in order to fully undertake
your studies as a consequence of any disability or medical condition.
……………………………………………………………………………………………………………………………………………….
……………………………………………………………………………………………………………………………………………….
Please state where you first heard about the Pécs Summer School program:
………………………………………………………………………………………………………………………………………………..
7622 Pécs Vasvári Pál u. 4. Hungary
Telephone: +36 72 501 500/12418 Fax: +36 72 501 508
E-mail: [email protected]
UNIVERSITY OF PÉCS
I certify that the information I have provided is true and correct and understand that the
university has the right to withdraw any offer made or cancel any registration if any of these
statements prove to be incorrect. I accept full responsibility for the information provided on
this form. If I am accepted on the program I agree that I will comply with all the governing
conditions.
Signature: ……………………………………………………………………………………….
Date: ……………………………………………………………………………………………….
Please complete and sign this form, then email it directly to the University of Pécs at:
Dr. Gyöngyi Pozsgai,
International Relations Co-ordinator
Centre for International Relations
[email protected]
7622 Pécs Vasvári Pál u. 4. Hungary
Telephone: +36 72 501 500/12418 Fax: +36 72 501 508
E-mail: [email protected]